Lum Jessica, Z Abidi Maheen, McCollister Bruce, Henao-Martínez Andrés F
Division of Infectious Diseases, University of Colorado, Denver, CO, USA.
Case Rep Med. 2018 Apr 16;2018:2723489. doi: 10.1155/2018/2723489. eCollection 2018.
Miliary histoplasmosis is a rare presentation that may mimic miliary tuberculosis. We report a case of miliary histoplasmosis in a 52-year-old male who was being treated with hydroxychloroquine, methotrexate, and sulfasalazine for his rheumatoid arthritis and presented to the emergency department with shortness of breath and fevers. Computed tomography (CT) chest revealed miliary pulmonary nodules. Urine antigen and serum antigen were negative; however, complement immunofixation assay and IgM were positive. The patient was initiated on treatment for pulmonary coccidioidomycosis and immunosuppression was held. However, a few days later, was isolated from cultures from bronchoscopy. This case highlights the difficulty in diagnosing histoplasmosis in immunocompromised patients and the importance of having a broad differential diagnosis for miliary pulmonary nodules. Tissue culture and histopathology remain the gold standard for the diagnosis of histoplasmosis. Further research needs to be conducted to determine the optimal duration of histoplasmosis treatment in immunocompromised patients.
粟粒性组织胞浆菌病是一种罕见的表现形式，可能类似于粟粒性肺结核。我们报告一例52岁男性粟粒性组织胞浆菌病病例，该患者因类风湿关节炎正在接受羟氯喹、甲氨蝶呤和柳氮磺胺吡啶治疗，因呼吸急促和发热就诊于急诊科。胸部计算机断层扫描（CT）显示粟粒性肺结节。尿抗原和血清抗原均为阴性；然而，补体免疫固定试验和IgM呈阳性。患者开始接受肺球孢子菌病治疗，并停用免疫抑制剂。然而，几天后，支气管镜检查培养物中分离出了（某种病菌，原文未明确）。该病例凸显了免疫功能低下患者组织胞浆菌病诊断的困难，以及对粟粒性肺结节进行广泛鉴别诊断的重要性。组织培养和组织病理学仍然是组织胞浆菌病诊断的金标准。需要进行进一步研究以确定免疫功能低下患者组织胞浆菌病治疗的最佳疗程。
